Individual provider Active NPI

Trista Samuelson, LCSW

  • Clinical Social Worker
  • Vernon, CT
National Provider Identifier
1932359668
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
006823 Issued in CT
Practice address
428 Hartford Tpke
Vernon, CT 06066-4841
Phone
(860) 858-4947
Fax
(215) 831-9887
NPI assigned
Sep 30, 2008
Last updated
Dec 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CW016916 PA
Clinical Social Worker 1041C0700X 006823 CT Primary

Addresses

Primary practice location

428 Hartford Tpke
Vernon, CT 06066-4841

Mailing address

428 Hartford Tpke
Vernon, CT 06066-4841
Phone (860) 858-4947

Other practice location 1

200 Retreat Ave
Hartford, CT 06106-3309
Phone (860) 545-7229

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081217000689 CT Practitioner - Clinical Social Worker 3375605819 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford HospitalGroup PAC ID 2567366016, shared by 6 NPIs, 1,040 clinicians

Practice addresses (Care Compare)

200 Retreat Ave
Iol Compus
Hartford, CT 06106-3310
Phone (860) 545-7500

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 972-2249

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as group
Quality
75.35
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CW016916PAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Natchaug Hospital, Inc. CurrentSince Dec 1, 2021 Accepting new patients
Hartford Hospital CurrentSince Nov 15, 2022 Accepting new patients
Hartford Hospital CurrentSince Nov 15, 2022 Accepting new patients

Locations

200 Retreat Ave
Hartford, CT 06106
Phone (860) 545-7000

189 Storrs Rd
Mansfield Ctr, CT 06250
Phone (860) 456-1311

428 Hartford Tpke
Vernon Rockville, CT 06066
Phone (860) 871-2508

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1932359668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "428 HARTFORD TPKE",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664841",
            "telephone_number": "860-858-4947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 HARTFORD TPKE",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664841",
            "telephone_number": "860-858-4947",
            "fax_number": "215-831-9887"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Retreat Ave",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061063309",
            "country_code": "US",
            "telephone_number": "860-545-7229",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "TRISTA",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW016916",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "006823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernon, CT

Sources for this page

Verify at the official NPI Registry.